A significant debate has originated regarding the inclusion of MG2A, a code for old age, in the ICD-11 for Mortality and Morbidity Statistics.
What is the ICD-11?
The 11th revision of the International Classification of Diseases, which goes into effect this month, is managed by the World Health Organization. Its stated purpose is twofold:
- allows the systematic recording, analysis, interpretation and comparison of mortality and morbidity data collected in different countries or regions and at different times
- ensures semantic interoperability and reusability of recorded data for the different use cases beyond mere health statistics, including decision support, resource allocation, reimbursement, guidelines and more.
Put simply, the ICD allows different nations with different healthcare systems to measure and tabulate the causes of death and dysfunction in a standardized way. When the mortality of various pathologies, such as cancer and hypertension, is statistically analyzed, such statistics are based on the ICD.
XT9T and MG2A
In the ICD-11, a new category of codes has been added: extension codes. These codes serve as adjectives, better explaining pathologies according to well-understood terms. For example, a cancer caused by occupational exposure to carcinogens can be defined separately from a cancer caused by hereditary factors. One of these extension codes is “age-related”: XT9T.
The other extension code, MG2A, was originally defined as “Old Age”. Defining aging as a disease, while controversial, has long been a goal of many members of the longevity community, and they greatly welcomed this inclusion in the ICD-11. However, this welcome was not universal, and the inclusion spurred quite a bit of debate.
An expression of concern
In October of 2021, an international group of psychiatrists published a comment entitled Not a disease: a global call for action urging revision of the ICD-11 classification of old age. This comment was largely focused on the negative perception of aging; among their arguments was a decline in certain psychiatric illnesses with age and the contention that frailty is a better code, as it derails the “healthy aging process”.
Most prominently, this argument was focused on the idea that the MG2A code was pathologizing chronological age, thus potentially leading to an increase in ageism and discrimination.
This concern was not focused on XT9T, which has been left unchanged.
In a Tweet from January 6, the well-known longevist David Sinclair lamented the fact that the MG2A code, rather than being simply “Old Age”, had been redefined as “Ageing associated decline in intrinsic capacity”. Alongside four other professionals, including Alex Zhavoronkov, he posted a rebuttal, Advanced pathological ageing should be represented in the ICD, which focuses on the fact that the original MG2A code was never to attempt to pathologize chronological aging; rather, its purpose was to pathologize biological aging, thus spurring the development of treatments that directly target it.
Dr. Khaltourina et al. also published a rebuttal of the same name that contained similar arguments, focusing on the fact that MG2A was meant to represent a “state of health” rather than a birth year. The authors express the opinion that while XT9T is useful for research and clinical purposes, labeling old age itself as a treatable pathology allows for the problems of older people to be specifically addressed: the exact opposite of ageism.
The ICD is a labeling system that places pathologies into categories, some of which are broader than others. Its goal is to track what people suffer from and what people die of in a coherent and organized way.
However, when considering the broad range of fundamental causes that make up aging, such categories become murkier. Biology is an extremely complicated system, and, as the authors of the ICD well know, any attempt to shoehorn its myriad causes and effects into any reasonably compact list of defined pathologies is bound to encounter problems.
While it does encourage the development of rejuvenative therapies, “old age” as a code lacks granularity. Biological aging is not a single, unified process by any means, and there is, of course, no such thing as a “healthy aging process”; every one of the myriad processes of aging contributes in some way to loss of function followed by death.
If pathologies related to old age were enumerated and placed in the ICD, particularly ones based on readily quantifiable metrics, such as epigenetic alterations, telomere attrition, and senescent cell accumulation, such systemic issues could be more easily targeted for treatment.
Whatever the case, if the myriad causes of aging can be enumerated, targeted, and ultimately intervened against, we may see an end to codes such as MB21.0, which defines age-associated cognitive decline as “a normative (non-pathological) deterioration of higher cortical functions such as thinking, reasoning, comprehension, calculation, learning, language, and judgment.”
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